Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994401 DEA: 09379304 EFIS: 0919000007
QA Service Level: 1
DIST-CO-RTE-PM: 09-INY-127-21.0/34.5,41.8/49.4
Work Description: PARTIAL DEPTH RECYCLE AND HOT MIX ASPHALT (TYPE A).
Location Description: INYO COUNTY NEAR SHOSHONE FROM 4.6 MILES NORTH OF ROUTE 178 WEST TO 7.6 MILES SOUTH OF ROUTE 190 AND FROM 0.3 MILE SOUTH OF ROUTE 190 TO NEVADA STATE LINE
Contractor Name: HAT CREEK CONSTRUCTION & MATERIALS INC.
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2023-04-03-59
TL Number from the TL Form:
Sample Submitted By Organization: CT D09 - Bishop Field Laboratory
Sample Organization Contact: (760) 872-5211
Type of Sample: Verification
Type of Material: Hot Mix Asphalt
Sample Taken Date: 04/03/2023
Date that the sample was received by the laboratory/organization performing the testing: 04/03/2023
The quantity of what the sample constitutes: 16 boxes of 3/4" Type A HMA with RAP
A brief description of the sample: 3/4" HMA-A-SP
From where was the sample collected: Manufacturer
Laboratory sample identification: JMF-01
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Wulfenstein Construction
